My life on the other side of the rabbithole

So many changes, so little patience to write about it all. I guess I’ll start with my latest.

Decision to leave my job.

I’m still 70/30 on the whole thing, but that’s still enough for me to cut ties and go. There is so much wrong with what I’ve seen and sometimes been a party of that I cannot take it anymore. I’m going into private practice where I belong. Where I’m my own boss, I make my own decisions and my own hours and I only answer to (technically) the insurance carriers during an audit of my files. I’m fucking done, y’all.

This hospital work is draining. I thought it would be easier because you don’t form attachments to people; they’re in and out – goodbye! Nope. Not this population. I see the same people week after month, month after year. Each time, coming into the ER with the same problem, same story:

Suicidal without a plan.
Withdrawal from drugs.
Chronic back pain that’s causing some suicidal thoughts – but they’re allergic to all pain medications except for Dilaudid.
Suicidal with a plan to OD on heroin; is an IV heroin user up to 1 gram per day usage – no history of attempts.

Now, when I say the same people, I don’t mean the same backstory. I mean the same fucking people. Joe Blow and Heywood Jablowme come in two, maybe three times a month. I’ve had patients discharged at 10AM denying suicidal or homicidal thoughts and come back at 2PM, saying they are suicidal and now, homicidal with no defined target or plan. And can they have something to eat? Because, well what the fuck else is this place for? I’ll go in to talk with them and ask how I can help them, what has helped in the past and some will turn me away. Because, you know – they really need some rest. Nevermind this is an ER and 5 beds away we have people having heart attacks and dying. People treat this place as a drunk tank or a free bed and breakfast. It drives me up the wall.

What makes things worse is policy. In the ER, it’s liability and licensing. Patients who even breathe the words suicide or harm are begging to be petitioned. (A petition is a legal document that allows hospital staff to hold a person involuntarily until they can be examined by a psychiatrist or psychologist to determine if inpatient psychiatric hospitalization is necessary). Patients don’t need to be petitioned because they have had thoughts of suicide. People with major depression have thoughts of suicide regularly and have no intentions of committing suicide. Petitioning them could prevent them from being honest with mental health personnel in the future when they actually do have the desire to act on those thoughts.

But lo and behold, they get petitioned and held for hours until they are evaluated by social work. Here’s the fun part. Depending on which social worker/counselor one gets, one’s outcome for getting placed inpatient or discharged home differ. It’s fucking subjective. I spent most of my first year trying to avoid putting people inpatient if they didn’t need it – and was fought by other social workers who would change my disposition after I left for the day (which would set me off), physician assistants, nurse practitioners and doctors.

I realized at year two, I was fighting a losing battle. It was even more of a loss when the “frequent flyers” became more aware of what was needed for hospitalization. Patients who we know have a very, very low likelihood of harming themselves or others, yet report otherwise with plans? No doctor would take the liability; they go inpatient despite all of us gritting our teeth, knowing full well they are malingering.

There are 2 sides to malingering, as far as I’m concerned. One is that the resources being used to care for the malingerer could be used for someone in a real crisis and that really chaps my ass. Two is that someone who takes to malingering needs some type of help. To feign illness for any type of secondary gain (e.g. Financial resources, medical care, etc.) takes a lot. The dedication used to feign illness could have been used to obtaining whatever the secondary gain was.

Anyway. Yes. The ridiculousness.

There is no upward mobility in the hospital unless you’re a nurse and I will be goddamned.

I miss doing therapy. I miss actually helping people that want to be helped. Every now and again, maybe once every 2-3 months, I run across someone who is legitimately looking for help and legitimately sick. That is awful considering how many people I’ll see in a night. Many of the people I see want pain meds or a bed to sleep in and food because they’re homeless. Some people just love the attention they get in an inpatient facility because it’s more than they get at home. None of these reasons are good enough to go to an inpatient psychiatric facility – NONE – yet these are the only reasons lately that I’ve been seeing people going. I get defeated seeing it. What good am I if this is all I’m doing? Filling beds with people that don’t need the help?

We’ve tried countless times to help the homeless people who come in, but most don’t want the help. They dismiss the shelter referrals we give out and have burned all their bridges at local transitional homes. It burns you out when you’re doing all the legwork, people do nothing and expect the world. The expectations along with the entitlement when one is not putting any effort is beyond irritating and exhausting.

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They fucked up and let me see some of my chart. Lordy lord… this is what I bug the husband with in the middle of the day.

And he stays.

And I misspoke. There’s a space under the diagnosis that allows for clarification, as being depressed all the time negates a bipolar diagnosis but what people fail to realize is depression is my baseline.

Sorry. My lack of chemicals, since a very young age, is all I’ve come to know. I’ve started back in therapy and I went back to the source: my childhood therapist. I worked with her from age 5 until my sophomore year in college, when I was raped. She said that I disappeared too soon – I had only scratched the surface in dealing with the rape and given my presentation, it seems that my mind hasn’t recovered.

My body is now paying the price.

So I spent a week between that session and the next thinking about everything: the rape, the aftermath, my life since then – my progress, my failures, my detours – everything – and it all made sense. My therapist was right: I stopped taking care of myself long ago. I can’t do that anymore. I have a family, I have a husband. I have a life. I have a life I don’t want to lose.

I told her that I have frequent suicidal thoughts with plans and access and means. But I have a huge protective factor: my husband. I told her that my husband lost his mother when he was 22 and he crawled inside a bottle to numb the pain. A year later, we started dating – he had one foot out of said bottle. I told him he’d have to stop drinking for us to date (at the time, I was a tee-totaler) and he quit. I will never send him back to that life. I will never leave him destroyed like that. He told me once that the only reason he attempts to get better paying employment is because of me, otherwise he would just live at home working a dead end job with no purpose. That leaves me to believe that I give him purpose. He gives me purpose and hope.

I was hospitalized so many times during the first 2 years of our relationship that my own family stopped visiting. My (now) husband visited everyday, without fail. He never missed a day. Even when I didn’t want him there, he came. He’d sit through my nasty attitude and come the next day. I finally thought to myself: Stop. Just fucking stop. This guy sees something in you. Something that’s good; something worth saving. Isn’t it worth it, perhaps, to stick around and find out what it is? Otherwise you may never know.

I still want to know. But if I keep hiding behind this trauma, I’ll never know. So it’s time to process it and move from victim to survivor.

The only way around in this life is through.

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So that’s it – it’s final. I’m killing myself. I’m done. I’ve used up all 9 of my lives and it’s over. I’ve cheated death so many times; I can’t escape it anymore. My Higher Power has told me my number is almost up.

I just get to do it slowly. Others get to watch; I get to watch. I’ll be slowly devoured by a disease that claimed the life of my grandparents in the most horrifying of ways. I watched my grandmother lose all her kidney function until she was on dialysis 3 times a week for 4 years. Over that time she developed dementia and became extremely labile: violent and hateful then minutes later, childlike, happy followed by apologetic and tearful for her violent behavior until it began again. This continued until she could no longer speak and began retaining water, slipped into a coma and died.

So that sounds like a great future. I’m excited about it – truly. Considering I’ve gotten the disease 30 years earlier than she did, I’m on the track to die sooner. Splendid! Just when I found the will and desire to live.

Life always throws you a curve ball.

The only way to reverse this is gastric bypass. Guess I’ve made my decision. I have no other choice. I made poor decisions that led me to this point. As much as food is addictive, I was never force fed. I chose what food to put into my body and I’m now paying a heavy price; I can’t get my glucose below 100 anymore. The only way I’ve gotten it to maybe 95 is to not eat for 8 hours – this is getting perpetually worse. I’ve been walking around my house complaining that I have no choice when I’ve been making choices that force me into a corner. I’m stuck choosing between body parts: my stomach or my pancreas and liver? Do I sacrifice one for the whole? Do I try to keep doing this on my own when I clearly cannot do it?

Sorry stomach. It’s been fun over these years, but you’ve become a liability and we need to go our own ways. We just don’t work well together – it’s not you, it’s me.

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You always think as a kid, how fucking untouchable you are. Invincible. Magic as hell. I can do this – I got this. Y’all just don’t know me. Even in your 20s, there’s a certain smugness that comes with having survived your teens (somewhat) unscathed; now bold, fresh and ready for adulthood.

Ohhh boy. Your 30s. They are sobering. You realize your body isn’t what it used to be, your parents aren’t what they used to be, your goals and expectations are miles apart because reality is a median that is difficult to cross.

Fuck. Your 30s. Are goddamn depressing. My mother is getting older and I want to cry every time I see her; I want to steal back every time I was a bitch, called her names, hurt her feelings, treated her like less than – despite how she may have made me feel. Seeing my dad is just as bad. He’s losing his hair, hunching over, getting skinny – his mustache is white! I remember when he looked just like Tom Sellack – no joke.

I’m stalling. I don’t want to tell you what’s up. If I tell you what’s up then I have to admit the truth to myself. I don’t like this truth. No matter how much I don’t like it, doesn’t make it any less true.

So I’m pre-diabetic now. So fucking kill me already. I haven’t eaten in 11 hours and my POC glucose is 82. Fuck me, that’s high. Had my doctor do an A1C test and BAM pre-diabetic. Oh and I have high cholesterol too – 200mg/dL. Great! Sign me up for the Fatty of the Month Club! Do they give out pins? How about a luncheon? FUCK. So the words “gastric bypass” have been tossed around.

Frequently.

A lot.

Like I’m probably gonna do it.

Haven’t told my gastroenterologist yet so that’s good. I’m sure he’ll sign off on it, you know, because gastroparesis, IBS, and GERD. What the fuck.

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How do fix a big mistake? How do you stop a whirling dervish? An avalanche? Rolling boulder off a mountaintop? That’s how this feels. I feel the weight of someone else’s decision – that I didn’t challenge – on my shoulders.

It’s days like this I wish I got my PhD like I’d planned.

Long story short and without HIPAA violations: someone who I felt was unnecessarily petitioned and viewed as a psychiatric patient ended up involuntarily sent to a psych facility. Because my higher ups – the attending – overrode my recommendation.

We’ve just created a psych history for a person who didn’t have one, didn’t need one. Great. I’m party to that and I feel like a piece of liquid shit. Thank you. No really – THANK YOU.

I don’t think these baseliners (ooh I like that!) truly understand the weight that having a hospitalization can carry on you. Mentally ill folk can’t carry guns here. With a psych history, it’s harder to obtain life insurance, you cannot enter the military, and imagine every time you saw a physician your symptoms were met with skepticism and disrespect.

Now remember you don’t have a mental illness. (See the twist?!)

That’s fucked up. If I knew then what I know now, I’m not sure I’d be here. I didn’t sign up to put baseliners, homeless baseliners, homeless addicts and just plain addicts in psych units. It’s not a shelter; it’s not rehab. When the truly mentally ill come along – get this – all the fucking beds are full!

Fuck the system and the peg leg it stands on. ::::spits on the ground::::

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Thinking about the election.
Thinking about work.
Thinking about nothing.
Thinking about suicide.
Thinking about my dog’s exercise plan.
And back to suicide.
And now on to my DVRed episodes of People’s Court.
I’m hungry.
Did you hear that?
I fucking heard something.
It’s dark over there, I’m not going over there. Fuck that. This house is full of stuff I don’t want to see at night.

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I am struggling with something that I shouldn’t be. This should be easy. This shouldn’t be my problem.

I have (unconsciously) made it my problem. And my grandmother can take some of the blame for this too, but I’ll get there in a second.

My mom, like most parents, gets on my last nerve at times. I have often whispered under my breath or said to myself “you need a man,” “go out and get a life,” or said to her face things like “your identity isn’t just ‘mom;’ there’s more to you than that – go find her again.”

How I want to eat my goddamn words.
How I want to shove my foot down my throat and swallow.
How I wish I could just shut the fuck up for once and mind my own goddamn business.
My advice is bullshit and I take it all back.

She found a man.
She went out and got a life.
She’s found her identity outside of being my mother.

…And I don’t fucking like it at all.
She can stop at any time now.
You proved your point.
Now, come home and watch TV all day with your hair all jacked up with the dogs in your lap.
Come on, quit fucking around.

She’s been dating a guy for the past few months and she seems to really like him a lot and the feeling appears to be mutual. They’ve been spending at least four out of seven days of the week together, going to dinner, movies, sidewalk fairs – stuff like that. Last week she asked me how I’d feel if she spent the night at his place.

OK, maybe I should explain. My parents divorced when I was 5 years old. I never really saw them together. I never really remember them kissing or hugging, being lovey-dovey or any of that shit. My mom didn’t seriously date when I was a kid because she didn’t want me exposed to “uncle” this and “uncle” that – too unstable for a kid. And she watched too much Law and Order: SVU.

So this is all new to me. My mom being touchy-feely with someone, or talking about being touchy-feely, kinda freaks me out. It’s not that I want her to be that way towards my dad (wow yeah no thanks gross), but in general I think I’ve blocked that version of my mom out.

I always joke that my parents are built like Barbie and Ken – not anatomically correct, just smooth plastic where their parts were supposed to be. I think by erasing any part of their being, I’ve been able to turn a blind eye to their humanity – their fallibility and imperfections. I complain that my mother has these ridiculous standards for people but I hold her to this ideal that she should only be my mother and not have her own life. I thought she was the only one attached to our relationship.

I was raised by my grandmother to take care of her and I see her growing, learning to trust again. I’m proud of her and scared – for her and for me.